O3298: Effects of Transport Team Composition on Neonatal Intubation Success

Background: Neonatal transport is necessary to move the smallest and sickest patients. Various team configurations exist for neonatal transport, yet little research has been done on optimal transport team compositions. One major concern with altering team composition is the ability to intubate neonates. Our institution transitioned from neonatal nurse practitioners (NNP) for neonatal transport to a critical care transport team (CCT) comprised of critical care nurses and paramedics. This study will assess transport team composition effects on neonatal intubation success when performed by a NNP vs CCT. We hypothesize no difference in intubation success when performed by NNP vs. CCT.

Methods: We conducted a retrospective review of neonates < 4 weeks of age intubated on transport from 2016-2023. Statistical analysis was completed using chi squared analysis and logistic regression to compare intubation success rates by NNP and CCT. Potential cofounding factors such as gestational age, birth weight, premedication, and videoscope use were also examined.

Results: We found 111 neonates required 119 transport member attempts for intubations. Infants were mean 34 weeks gestation (23-41 weeks) and birth weight of 2465 grams (500-4530g). Overall successful intubation occurred in 84% of the cases with no difference between NNP or CCT groups (p=0.68), Figure 1. When controlling for confounders, no statistical difference was found. (aOR: 0.197, Cl:0.032-1.193). If our team members were not successful, the referral hospital provider intubated in 8 cases with 1 left extubated and 1 LMA placement.

First attempt success was higher in the CCT than NNP (51.8% vs. 30.6%: p=0.0324). With successful first attempt intubations, significantly more premedication (p=0.006) and videoscope (p=0.003) were used in the CCT group. When controlling for premedication and videoscope use, there was no difference in the first-time success of the two groups (p=0.9665).

Conclusion: Overall, there was no difference in neonatal intubation success between NNP and CCT composition. This supports critical care transport teams comprised of critical care nurses and paramedics can successfully intubate neonatal patients with similar rates to neonatal nurse practitioners. No difference in team composition for neonatal intubation success allows for different staffing models based on your institution needs and availability of providers.